Western Carolina University
Institutional Animal Care and Use Committee
ANNUAL RENEWAL FORM
Principal Investigator:
Protocol Title
Protocol Number:
Prior Approval Dates
Check the appropriate box(es) below:
Terminated prior to completion.
Additional Requirements: Please provide the reason for the termination of the project, specifying any
involvement of animal use in the termination. If your protocol has been completed or terminated, then you must
submit a completion report. Your completion report must indicate the number of animals used, the number of
animals originally approved for use by the IACUC, and anything noteworthy or unusual with the protocol.
Completed according to protocol.
Additional Requirements: If your protocol has been completed or terminated, then you must submit a
completion report. Your completion report must indicate the number of animals used, the number of animals
originally approved for use by the IACUC, and anything noteworthy or unusual with the protocol.
Renew Protocol with revisions.
Additional Requirements: Please provide an annual progress report. It must indicate the number of animals you
have used, how many animals remain to be used, and anything noteworthy or unusual with the protocol. Briefly
state the reason for these changes, indicating how it relates to the research goals described in your approved
protocol, or to new research goals.
Animal numbers:
Additional Requirements: Attach a description of any proposed changes in the animal species or
numbers listed in your approved protocol. For each species, clearly indicate and FULLY JUSTIFY
the amount of any proposed increase in the total number of animals to be used for the current
year.
Animal species:
Additional Requirements: Attach a description of any proposed changes in the animal species or
numbers listed in your approved protocol. For each species, clearly indicate and FULLY JUSTIFY
the amount of any proposed increase in the total number of animals to be used for the current
year.
Animal care:
Additional Requirements: Attach a description of any changes in the animal care procedures described
in your approved protocol. If pain or stress involved is anticipated, please describe.
Animal experimental procedures:
Additional Requirements: Attach a description of any proposed changes in the animal experimental
procedures described in your approved. If pain or stress involved is anticipated, please describe.
Other:
Renew protocol with no revisions.
Additional Requirements: Please provide an annual progress report.
IACUC Renewal Form
February 2013
Signature of Principal Investigator
Date
ATTACH ADDITIONAL PAGES AS NECESSARY
IACUC Renewal Form
February 2013